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Old as Society, Social Anxiety Is Yielding Its Secrets

''Man seeketh in society comfort,'' Francis Bacon asserted, but you could have fooled Robert Suhoza. Gatherings of his fellow humans have rarely inspired in Mr. Suhoza a sense of consolation and well being. Usually, it has been more like sweating, heart-pounding dread.

Stand up and give a speech to a group of co-workers? He would prefer to be trampled by elephants. Make small talk at a cocktail party? Just go ahead and shoot him. Introduce himself to a room full of strangers? Maybe he'll just come back some other time.

Mr. Suhoza, a 53-year-old Connecticut businessman, has lived with this social unease since childhood, fretting and worrying, afraid he will say something stupid, afraid people will see how nervous he is. At work, he dreaded meetings and sat quietly, praying he would not have to speak. He wanted to read a passage of Scripture at his niece's wedding, but in the end had to tell her that he just could not do it.

Even answering the phone seemed at times an insurmountable task: He knew he should pick up the receiver, but he was paralyzed by not knowing who was on the other end, or what the caller wanted.

Last year, Mr. Suhoza finally sought help at the Yale University Psychological Services Clinic. To his surprise, he learned that his plight had a name -- social phobia or social anxiety disorder, a condition attracting increased attention from mental health experts, in part because of the availability of new drug treatments and novel brain-imaging technologies that are yielding clues to the disorder's underlying biology.

And while Mr. Suhoza often felt he was the only human on the planet with such a disabling affliction, it turns out he has lots of company. National surveys indicate that one in every eight Americans meet the diagnostic criteria for social anxiety disorder at some point in their lives, making it the third most common psychiatric condition. More women suffer from social phobia than men, studies show, though men are more likely to seek treatment, perhaps because society deems extreme shyness in males less acceptable than in females.

Descriptions of the socially anxious appear throughout history. Hippocrates wrote of a man who ''through bashfulness, suspicion and timorousness will not be seen abroad''; Charles Darwin, exploring the evolutionary roots of blushing, described a dinner party given in honor of a very shy man. Rising to return the thanks of the guests, the man began his speech, gesticulating for emphasis as he went along but never actually uttering a single word. ''His friends, perceiving how the case stood, loudly applauded the imaginary bursts of eloquence, whenever his gestures indicated a pause.'' The man later remarked to a friend, Darwin wrote, that he thought the speech had gone quite well.

Only in the last two decades, however, have researchers begun to investigate social anxiety disorder in any depth, or to distinguish it fully from other psychiatric conditions in which anxiety features prominently, like panic disorder and agoraphobia. The diagnosis first appeared in the 1980 edition of the official Diagnostic and Statistical Manual of Mental Disorders; before that, all phobias were lumped together.

Psychiatrists divide those who suffer from social phobia into two groups. Some, like Mr. Suhoza, experience pervasive anxiety that is triggered by a multitude of social situations and interferes with their daily lives. For others, the fear is more specific: They may be bold as roosters at cocktail parties but fall to pieces when they have to deliver a speech or perform in public.

Dr. Michael Liebowitz, a Columbia University psychiatrist and director of the Anxiety Disorders Clinic at New York Psychiatric Institute, said he has treated corporate vice presidents so frightened of public speaking that they consider abandoning their careers just to avoid the podium, and concert musicians who, when a performance looms, spend the hours leading up to it shaking and vomiting.

Beyond these two groups is a large, if unquantified, number of people who are shy and socially uncomfortable, but not to the degree that it impairs their lives. Still, they feel much more at ease at a party after the first glass of Cabernet. Or they banter confidently with colleagues while running an internal monologue that goes something like ''O.K., here comes that new guy from Department 12. I better say something witty. Jeez, that was stupid. Now he probably thinks I'm a boob.''

Some degree of social anxiety, researchers point out, is not only normal, but essential. ''If you've never been concerned about the opinion of others, then you've never been an adolescent,'' says Dr. Richard Heimberg, director of Temple University's Adult Anxiety Clinic and developer of a widely used group therapy treatment for social phobia. ''And if you don't think about it a bit every day, you're probably not a very sensitive person.''

Indeed, like the fear of snakes, heights or deep water, social anxiety probably has its roots in natural selection. Most animal species count among their ranks individuals who are unusually bold or extremely timid, and a growing body of evidence suggests these temperamental differences are largely genetic.

In nature, temerity has obvious payoffs: Intrepid animals explore new territory. They fight their way to the top of the dominance hierarchy, and are first to get the food -- and to snag a desirable mate. But timidity also has its advantages. The fearful, though they may rank lower in the social order, know when to defer to the top brass, and are less likely to be killed picking fights with neighborhood toughs. A variety of coping strategies, scientists speculate, may allow adaptation to changing environments, favoring species survival.

Research on timidity in animals is proving fruitful to scientists probing the biological underpinnings of social phobia in people. Studies of mice and of monkeys bred to be timid, for example, indicate submissiveness may be associated with abnormalities in a number of messenger chemicals in the brain, in particular a neurotransmitter called dopamine.

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Recent studies using a three-dimensional imaging technique called Spect (or single photon emission computed tomography), which allows measurement of chemical structures in the brain, suggest dopamine may be involved in humans, as well. A 1997 Spect study by Finnish researchers found that patients diagnosed with social phobia showed abnormalities in the brain's dopamine system in comparison to normal subjects. And in a small, still uncompleted Spect study at Columbia University, Dr. Franklin Schneier, Dr. Liebowitz and their colleagues have found indications that socially phobic patients may have fewer brain dopamine receptors. Antidepressants that affect brain dopamine levels have proven effective in alleviating symptoms of social phobia; but so have newer antidepressants, like Paxil, that alter levels of another neurotransmitter, serotonin. And scientists are still a long way from knowing how such brain chemicals act separately or together to influence behavior.

Social phobia and shyness overlap, yet to what extent is still unclear. In humans, shyness appears to have a strong genetic component. In a series of now classic studies, Jerome Kagan, a Harvard University psychologist, and his colleagues, found that 10 to 15 percent of children begin life with what Dr. Kagan calls ''a temperamental bias to be shy, timid and fearful,'' a propensity identifiable even in infancy. Such ''inhibited'' children become unusually quiet when faced with unfamiliar adults, hang back in groups of peers they do not know, and even at four months are more reactive and more irritable in response to stimulation.

At least some of these children grow into adults classified by psychiatrists as socially phobic. Certainly, many people with social phobia remember being inordinately shy in childhood. A 35-year-old electrical engineer who sought help at The Shyness Clinic in Portola Valley, Calif., for example, still winces recalling a classroom show-and-tell in nursery school. She had brought in a deer's antler, discovered behind her house in the Los Angeles hills. ''I remember repeating over and over in my head, 'I found it in my backyard,' '' she said, ''but I just couldn't say anything.' ''

A 38-year-old social worker remembers walking to school at the age of 11 as ''like going into a war.'' She added, ''I felt like people were judging me. I don't know how I survived.''

But a genetic predisposition toward shyness is just that; in a human child the contribution of biology is shaped, modified, and sometimes entirely contravened by the power of environment. Of Dr. Kagan's inhibited children, about 70 percent outgrew their extreme shyness by the age of 7, though they remained more quiet and subdued than their uninhibited counterparts.

The interplay between genetic and environmental forces is easier to see in primates who, unlike humans, can be raised in controlled circumstances. Dr. Stephen Suomi, chief of the Laboratory of Comparative Ethology at the National Institute of Child Health and Human Development in Bethesda, Md., and his colleagues are studying rhesus monkeys that show temperamental differences similar to those of Dr. Kagan's shy children. These ''uptight'' monkeys, representing about 20 percent of the wild population studied by the researchers, are from birth more vigilant, more reactive to disruption in the environment and more fearful than their peers.

Uptight males linger longer with their mothers' troops than other males, who emigrate to a new troop at puberty. The shy males' submissiveness usually lands them low in the dominance rankings. They carry higher parasite loads than other monkeys -- suggesting prolonged stress may affect their immune systems -- and display other physiological differences, including higher stable heart rates and elevated levels of stress hormones.

But Dr. Suomi's team has found that when monkeys bred to be uptight and timid are raised by successful, secure, high-ranking mothers, a kind of miracle occurs. ''They learn from their mothers how to cope with new social situations,'' Dr. Suomi says. ''They get very good at recruiting friends and seeking help, and they often end up at top of the dominance hierarchy.''

A similar healing can take place in people. ''Just as the mother can help heal the child, the girlfriend can help heal the shy guy,'' said Dr. Ethel Person, a New York psychoanalyst. For those who are not so fortunate, dealing with their fear is often a lifelong process. Some seek out jobs that shield them from a surfeit of human interaction; they become night guards, or computer programmers, or astrophysicists.

Others eventually find their discomfort intolerable. For a 42-year-old nursing home recreation therapist in Connecticut, the limit came when she changed jobs and became preoccupied with fears she would embarrass herself in front of her new co-workers. For a 35-year-old Temple University graduate student it arrived when he worried, weeks in advance, about a class presentation, and could not stop thinking, ''I'm going to screw up. I'm going to make a fool of myself. My voice is going to crack.''

Many treatment programs are designed to combat just such self-flagellating thoughts. Using a model called ''cognitive-behavioral therapy,'' they challenge assumptions socially anxious people often make reflexively: that they are being closely observed by everyone in the room, for example. At the Yale clinic, Mr. Suhoza discovered that he did not appear as nervous as he had feared. He said he was learning not to compare himself constantly with others, or to assume they are judging him badly.

Group therapy, which allows patients to share their experiences with others, is a preferred mode of treatment, though half the battle, said Dr. Michael Otto, a psychiatrist at Harvard Medical School, is often to coax socially anxious people in the door in the first place.

If work by Dr. Philip Zimbardo, a Stanford University psychologist, is any indication, clinics treating social phobia may draw even more customers in the future. Shyness, Dr. Zimbardo has found, is on the rise. In surveys, more than 50 percent of young adults describe themselves as chronically shy, up from 40 percent in the 1970's. In part, he said, the jump may reflect the rise of E-mail, automated gas pumps, video games, A.T.M.'s and other technologies that remove human beings from the ordinary equations of life. With fewer chances to practice social skills, children may find face-to-face interaction more difficult. ''And if you have a any tendency toward shyness,'' Dr. Zimbardo said, ''that's going to amplify it.''